Our Story

Facing the Moral Dilemma of an Ectopic Pregnancy

Medical technologies are advancing at such a rate that it has been difficult for Church teaching to keep pace. Still, in the face of the new moral dilemmas born from these medical breakthroughs, the long-standing principles of Catholic moral doctrine offer reliable guidance to the Christian.

Having recently experienced such a crossroad of science vs. faith, I want to tell you about the brief but remarkable life of my baby. The story began about six weeks ago when, as a result of routine natural family planning, my wife, Diana, and I found out she might be pregnant with our fifth child. After two over-the-counter pregnancy tests, our hunch was confirmed. Surprised and overjoyed, we immediately began to pray for this new life and to thank God for his wonderful gift.

Over the next two weeks, our joy turned into concern and uncertainty as we soon learned that the pregnancy was not going normally and was possibly ectopic. We immediately entrusted the whole situation and the baby to the Lord. I decided to do some research and soon discovered that in most ectopic pregnancies, the baby embeds in the fallopian tube. When this occurs, there is no chance of survival. As the baby attaches to the tube and grows, the tube eventually ruptures, ending the life of the baby and threatening the life of the mother.

After finding out about our dilemma, I discovered that there is a moral debate today concerning various procedures for solving this kind of problem. The first proposed procedure calls for the mother to take a pill, methotrexate, which breaks down the environment around the fetus in the fallopian tube, directly causing a miscarriage. The second procedure, called linear salpinotomy (ostomy), is performed by entering the fallopian tube through the belly button and directly removing the fetus by suction.

The goal of these two procedures is to directly remove the fetus while saving the fallopian tube for the possibility of future pregnancies. Interestingly, both procedures are often presented to patients, without any moral considerations, as the way to assure the least damage to the mother's body. What doctors admit, though, is that these procedures usually leave the fallopian tube scarred, significantly increasing the chances of future ectopic pregnancies.

Medical or Moral Perspective?

As the day arrived, the doctors confirmed that Diana did have a tubal pregnancy. During the waiting time and on the day of decision, the doctors offered us both medical procedures as the only two possible alternatives. When I asked one of the doctors about the “baby” she instead referred to “a mass of cells, “ “a blob of tissue” that was “nonviable,” needing to be removed in the most “conservative” way to cause the least damage to the mother.

Aware of the moral implications, I reminded the doctors that we were in a Catholic hospital. As for Diana and myself, I said we saw this situation more from a moral perspective than a medical one. I explained that human life begins at the moment of conception when the egg is fertilized and must be absolutely respected and protected from that moment onward (Catechism of the Catholic Church, No. 2270). Therefore, any attempt to directly remove the living fetus, even if it is deemed nonviable as is eventually the case in tubal pregnancies, has always been recognized by the Church as gravely immoral and essentially similar to abortion.

The first procedure the doctors had recommended, in which the mother ingests methotrexate to cause miscarriage, is essentially the same as the use of the “morning-after pill,” only at a later stage in fetal development. The second procedure, salpinotomy, is aimed at directly intending, by the procedure itself, the termination of the life of the baby.

One moral theologian, Jesuit Father Thomas J. O'Donnell, a consultant to the U.S. Catholic Conference Committee for Continuing Directives for Catholic Health Facilities, said that “the (direct) removal of a non-viable fetus from the site of the implantation (fallopian tube), has always been recognized in the teaching of the Church as a grave moral evil. … [A]borting a fetus from a fallopian tube is no different than aborting it from the uterus itself.”

The 1996 National Conference of Catholic Bishops document, Ethical and Religious Directives for Catholic Health Services, states: “In case of extrauterine (including ectopic) pregnancy, no intervention is morally licit which constitutes a direct abortion.” On the other hand, the document continues: “Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman (i.e. a salpingectomy) are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child” (Nos. 45, 47).

An Acceptable Alternative

Despite these directives, some theologians unfortunately contend that methotrexate and salpinotomy may be permitted. Part of the debate about these two procedures emphasizes that they have yet to be directly condemned by the Church. Meanwhile, many patients are unaware that there are any moral issues involved.

I mentioned to the doctors another procedure approved by the Church, salpingectomy. It is an operation that entails directly removing the damaged fallopian tube in the area where the baby is located. (The doctors later admitted this was an easier and less risky operation, though in their opinion it was archaic and “unnecessarily harsh” to the mother's body.) The intention of the doctor and the patient and the procedure itself are radically different from both the proposals the doctors originally made to us. The operation is oriented to saving the life of the mother, not to taking the life of the baby. As a secondary effect that is not directly intended, the life of the baby is lost.

In a February 1999 article in the Catholic Medical Association's Linacre Quarterly, physician John E. Foran wrote: “Therefore since the immediate effect of methotrexate and saplingotomy (ostomy) is the death of the fetus, the principle of double effect (as some try to apply it) is not applicable because the act is evil.” He adds that salpingectomy, the third procedure I had suggested, is morally acceptable.

The doctors somewhat reluctantly agreed to perform the procedure that I had proposed.

Diana and I had to grapple with allowing the death of our daughter. We felt the way Abraham must have felt leading his son Isaac to the sacrifice, or the way Mary felt offering Jesus on the cross. But, at the same time, we felt an overwhelming sense of peace and assurance knowing that God's hand was at work in all this. We gathered holy water to have the baby baptized by the nurse right after its surgical removal. We decided to name her Maria Goretti Bowring because the day, July 6, was St. Maria's feast.

As it turned out in the end, the original doctors who had suggested the abortive procedures did not perform the surgery. Diana went into surgery as their shifts changed. A well-respected Catholic doctor performed the surgery and was openly inspired by our decision.

Awaiting a Definitive Statement

During and since the operation, I have felt a great wonder and privilege at the gift of our baby. A priest friend of ours recently told us that the Lord has shown his love for our family in a special way by giving us such a close and powerful intercessor in heaven. We are thankful to the Lord for making us aware of the moral issues at stake and for giving us the grace to be faithful to the Church's teachings.

The ectopic pregnancy debate has elicited a great deal of controversy and opinion, most of which is misinformed. Dr. Foran, in his Linacre Quarterly article, said “the debate must be brought to a conclusion with unambiguous teaching from the Magisterium.” Dominican Father J.A. Di Noia, executive director of the American bishops' Doctrine and Pastoral Practices office, has stated: “Tubal pregnancy is another example of the moral issues being raised by modern medical advances. Conscientious of the moral issues involved, the Church judiciously deliberates on these issues before promulgating a definitive statement.” In the meantime, he agreed, “the Church's wellspring of moral teachings can act as a guide in such matters.”

Diana and I are also hoping, in telling our daughter's story, to encourage hospitals, doctors and other parents faced with this same moral dilemma to make the right moral decisions. May Maria Goretti Bowring's life, like that of other innocents of tubal pregnancies, encourage the Church to explicitly clarify her definitive teaching in reference to tubal pregnancies.

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